Abstract Otology 2000 C16-1

Konrad Schwager MD, L. Pfreundner MD, M. Flentje MD, Jan Helms MD

ENT Dept Univ of Würzburg D-Würzburg

Between 1978 and 1997, 30 patients (17 female, 13 male) were treated atthe departments of otolaryngoloy and radiation oncology for carcinoma of the outer ear canal and middle ear. The patients age at time of diagnosis was 60 years mean (range 26-85 years). 27 patients came for initial treatment, 3 patients with recurrent disease after primary treatment at an other institution. Most tumors were squamous cell carcinomas (n=23), 5 were adenoid cystic, 1 was a mucoepidermoid carcinoma and 1 a papillary adenocarcinoma. At time of diagnosis 6 patients showed dural tumor infiltration, in 2 patients the temporal lobe was invaded by tumor. 5 patients (17%) had lymph node metastases. These were located intraparotideal (n=3), infraparotideal (n=1) and retropharyngeal (n=1). Distant (pulmonary) metastases were found in 1 patient with dura infiltration 5 months after diagnosis. According to the Pittsburgh staging system 7 patients were stage I, 1 patient stage II, 10 patients stage III, and 12 patients stage IV. Therapy included surgical procedures (external auditory canal resection, partial temporal bone resection, subtotal temporal bone resection) followed by external beam radiation therapy (EBRT) of median 70 Gy. In cases of recurrent or residual tumor after surgery and EBRT a 192-Iridium HDR (high dose rate) brachytherapy was administered. The overall survival rate was 61% at 3 years and 53% at 5 years. 48% of all patients were free of disease at 5 years, the 5 year disease free survival rate for in-sano resected patients was 100%.

Abstract Otology 2000 C16-2

Yurij A. Soushko MD, PhD, Oleg Borissenko MD, Rustem M. Trosh MD, PhD, Victor V. Gudkov MD, Ilona A. Srebnjak MD

Otolaryngology Research Institute UKR-Kyiv

Eighteen patients with skull base tumors treated at the Kyiv Otolaryngology Research Institute between 1995 and 1998 were submitted to present retrospective study. The patients were treated surgically with combined transmastoid-transcervical approach, modified according to the individual tumor growth. In ten patients performed infratemporal fossa approach of Fisch and Mattox with obliteration of middle ear spaces. There were 13 women and 5 men. Ages ranged at the time of surgery from 20 to 50, with a median age of 38,4. The average duration of symptoms was 5,6 years. Three patients suffered neuroma of the facial nerve, one had a meningioma in the jugular foramen area, 11 had a glomus tumor and 3 were with malignant tumors. The tumor sizes up to 2 cm was found in 5 patients, up to 3 cm in 2 patients, up to 4 cm in 5 patients and more than 4 cm in 6 patients. The tumor was removed completely in ten patients. In a further 8 patients the tumor was resected subtotally and these patients received postoperative radiotherapy. The reasons for incomplete tumor resection were interruption of the surgery because of severe hemorrhage and spreading of a tumor on ICA. The facial nerve was not damaged by a tumor in 7 patients, during the operation we saved its integrity. For one patient with the facial neuroma after removal of a tumor the VII-XI anastomosis was made; 6 patients underwent the VII-XII anastomosis. It was impossible to make anastomosis for 4 patients because of the nerves-donors damage. Follow-up intervals were from 12 to 45 months (average 28,2). The patients with malignant tumors died in terms from 6 to 10 months after surgery. The dysphagy is marked in 3 patients, 2 had the hoarseness. The function of a facial nerve is saved or restored completely in 8 patients, 4 patients have a facial paralyses House grade II, 2 patients grade III and 4 patients grade VI. The hearing remained unchanged in 7 patients. In our opinion the combined transmastoid-transcervical approach is the most suitable access to the skull base tumors, which allows to remove a tumor and save integrity of a facial nerve or to make its neurorrhaphy.

Abstract Otology 2000 C16-3

Vesna Ciric MD, Milan Stankovic MD, PhD

University ENT Clinic YU-Nis

Temporal bone carcinoma is a rare disease, but it has very aggressive course and bad prognosis. Clinical presentation of temporal bone tumor is usually insufficiently specific, and when it is obvious the disease is advanced with rapid progression and limited therapeutic success. Different surgical techniques for temporal bone resection are developed, but their success is difficult to access. The aim of this study was to analyze the clinical characteristics, surgical results of twelwe patients who underwent surgical therapy for secondary temporal bone tumor. We divided them in stages according to Arriaga et al. (1990). Partial temporal bone resection, subtotal resection (petrosectomy) or total temporal bone resections were surgical methods of treatment. Postoperative irradiation with 6 000 cGy during 6 weeks in 30 fractions was applied in all the patients. Secondary affection of bony external meatus and middle ear was the result of local invasiveness of planocellular (58%) or basocellular carcinoma (42%). For secondary tumor involvement five years survival rate amounted 75%, 66%, and 0%, depending on the stage of disease. It can be concluded that prognosis of temporal bone carcinoma directly depends on the propagation of tumour. Computerised tomography is a reliable method for determination of the propagation and for planning the treatment. Temporal bone resection with postoperative irradiation is the method of choice of temporal bone carcinoma.

Abstract Otology 2000 C16-4

Thomas P. Nikolopoulos MD, PhD, Gerald M. O'Donoghue M.Ch FRCS

E.N.T Department Nottingham University Hospital GB-Nottingham

Introduction: The outcome of skull base surgery has been evaluated extensively by surgeons throughout the world. However, the patients' perspective has recently become of increasing importance in the assessment of surgical outcomes1,2. Material and methods: 52 patients were randomly selected following skull base surgery (removal of acoustic neuromas or meningiomas). One, at least, year after surgery, the patients were asked to assess the outcome of the operation. Results: 45 out of 52 patients (87%) reported that the operation was partially or fully successful and 47 out of 50 (94%) reported that their family/friends believe that the outcome of surgery was the same successful. A degree of disappointment was expressed by 12 out of 52 patients (23%). With regard to the effect of the adverse results of surgery on their overall life, 22 out of 52 patients (42%) reported that it was moderately or greatly affected. However, only 3 out of 52 patients (6%) reported that they would not recommend the same operation to a member of their family or a close friend in case he/she had a similar tumour. Conclusion: The majority of patients considered and reported partially or fully successful the outcome of surgery for the removal of skull base tumours. Only a small minority considered the operation as failure, although over 40% of patients experienced adverse results of the operation that had moderately or greatly affected their overall life. References 1) Irving RM, Beynon GJ, Viani L., Hardy DG, Baguley DM, Moffat DA. The patient's perpective after vestibular schwannoma removal: quality of life and implications for management. Am J Otol 1995; 16 (3): 331-337. 2) Nikolopoulos T., I. Johnson, G. O'Donoghue. Quality of Life After Acoustic Neuroma Surgery. Laryngoscope 1998; 108(9): 1382-1385.

Abstract Otology 2000 C16-5

Janez Zupancic MD, Saba Battelino MD, Miha Zargi MD, PhD

Department of ENT and CFS University Medical Centre SLO-Ljubljana

In the last 15 years we treated 14 patients with malignant tumours of EAEC and the MEC, primarily surgically with following radiotherapy. In 12 cases we did the classical LTBD with no obliteration of the entrance of EAEC. In these cases, during and after radiotherapy, we had a lot of difficulties with inflammations and discharge from operative cavity, as well as the osteomielitis. In two cases we performed the LTBD (one modified), where we removed all the EAEC, the ear drum and the ossicules. In one case we left open the tuba Eustachii for the ventilation of the remanding mucosa. In the second case, we performed also the mastoidectomy and removed the mucosa of MEC. In both cases we closed the entrance of the EAEC with the skin of the tragus. In these two cases we had no complications during and after radiotherapy with 61,9 Gy. Both patients are now 3 and 12 years after therapy, with no loco-regional recurrence of primary disease and with no late complications after surgery or radiotherapy. We think the LTBD with occlusion of the entrance of EAEC and radiotherapy is a therapy of choice for malignant tumours of EAEC and MEC in early stages. The obliteration of the entrance into the EAEC reduces the complications during and after the radiotherapy, but on the other hand, makes the eventual recidiv or residuum later discovered. According to the very bad prognosis in such cases we still speak in favour of obliteration of the entrance of EAEC.